内镜经鼻入路和经上颌窦入路中翼腭窝的应用解剖

Surgical Anatomy of Pterygopalatine Fossa in Endoscopic Endonasal and Trans-maxillary Approaches

目的为涉及翼腭窝的内镜经鼻和经上颌窦入路手术提供解剖学资料。方法对5具福尔马林固定的头颅湿标本,采用内镜经鼻和内镜经上颌窦入路,按手术步骤对翼腭窝进行应用解剖学研究,并辅以显微镜下经颅外侧颞下窝解剖,观察并描述翼腭窝解剖结构及其与毗邻结构之间的解剖关系。结果在内镜经鼻和内镜经上颌窦入路中,切除腭骨垂直板和上颌窦后壁后可显露翼腭窝内部解剖结构;翼腭窝内主要的动脉结构为上颌动脉及其终支蝶腭动脉和腭降动脉;翼腭窝内的主要神经结构为上颌神经、翼管神经和翼腭神经节;循解剖标志去除翼腭窝周围的骨性结构后可显露翼腭窝与海绵窦、眶尖、颞下窝等区域的解剖关系。结论内镜经鼻入路和内镜经上颌窦入路可有效显露和处理翼腭窝内解剖结构。

Objective To study the surgical anatomy of pterygopalatine fossa in endoscopic endonasal and endoscopic trans-maxillary approaches.Methods Five adult formalin-fixed cadaver specimens（10 sides） were examined.The pterygopalatine fossa was exposed and explored step by step by using endoscopic endonasal and endoscopic trans-maxillary approaches.The observation of infratemporal fossa was facilitated by dissection under surgical microscope.The anatomic structures and their relationship with adjacent regions were carefully observed and recorded.Results In endoscopic endonasal or trans-maxillary approaches,the pterygopalatine fossa could be exposed after removing the posterior maxillary wall and the perpendicular plate of palatine bone.The main neurovascular structures in pterygopalatine fossa included the maxillary nerve,vidian nerve,pterygopalatine ganglion,maxillary artery and its terminal branches,the descending palatine artery and sphenopalatine artery.After opening the pterygopalatine fossa,following the associated anatomic landmarks,the adjacent regions,such as the cavernous sinus,orbital apex and the infratemporal fossa could be reached and exposed.Conclusion The anatomic structures of pterygopalatine fossa can be effectively exposed and manipulated through endoscopic endonasal and trans-maxillary approaches.